Provider Demographics
NPI:1801836796
Name:WAHL, DAVID R (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:WAHL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:8999 W CENTRAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212
Mailing Address - Country:US
Mailing Address - Phone:316-729-1633
Mailing Address - Fax:316-729-2635
Practice Address - Street 1:8999 W CENTRAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212
Practice Address - Country:US
Practice Address - Phone:316-729-1633
Practice Address - Fax:316-729-2635
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0104024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660139Medicare ID - Type Unspecified